Application Form

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Application Form

□	Girls' Week	August 4-7
□	Boys' Week	August 11-14
□	Goalkeeper Training
□	Future Stars Academy August 12-14

Girls/Boys Week Camp Hours:	9:00am to 3:00pm	Future Stars Academy Camp Hours: 9:30am-12:30pm
4-Day Tuition:	$175.00 Team discounts for day campers only (contact us for details)
FSA Tuition:	$90.00

Name:____________________________________________________

Address:__________________________________________________

Town:____________________________________________________

State:____________________________ Zip:________________

Home Phone ( ______ ) _____________________________________

Work Phone ( ______ ) _____________________________________

Date of Birth __________________________ Age ___________

Grade in School (Sept.2006)_________________________________

Insurance Co. _____________________________________________

Policy # __________________________________________________

Copy of recent physical exam and immunization records must accompany final payment.

T-Shirt Size (circle one):

Youth-	Medium	Large
Adult-	Medium	Large	XL

Parent/Guardian___________________________________________
(Authorizes enrollment and treatment in case of injury or illness and releases camp and other organizations from any liability (see waiver).)

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